Is there hope to reach the Zero by 30 target for dog-mediated human rabies?
Authors: Deborah Nadal, Katrin Bote, Bernadette Abela
Journal: The Lancet Global Health (2023)

The Zero by 30 strategy—the global plan to eliminate dog-mediated human rabies deaths by 20301WHOFood and Agriculture Organization of the United NationsWorld Organisation for Animal HealthZero by 30: the global strategic plan to end human deaths from dog-mediated rabies by 2030.https://apps.who.int/iris/handle/10665/272756Date: 2018Date accessed: September 1, 2023Google Scholar—has increased awareness of rabies throughout the world and instilled a sense of urgency in implementing control strategies. Targeted calls for action appear to be motivating policy makers and the public in rabies-endemic countries to achieve this goal. Given the impact of the disease on particularly vulnerable and marginalised communities where rabies currently causes an estimated 59 000 human deaths per year,2Hampson K Coudeville L Lembo T et al.Estimating the burden of endemic canine rabies.PLoS Negl Tropl Dis. 2015; 9e0003709Google Scholar this trend is welcome; however, with only 7 years until 2030, many people now question whether it is still possible to reach the target of having no further human deaths due to dog-mediated rabies. Post-exposure prophylaxis can bring down the rabies death toll swiftly if bite victims can quickly access affordable rabies biologicals (vaccines and immunoglobulins). Now that the Gavi Board of the Vaccine Alliance has approved resuming their 2018 decision to start the roll-out of human rabies vaccines for post-exposure prophylaxis3GaviFrom rabies to hepatitis: Gavi to start rolling out new vaccines to lower-income countries.https://www.gavi.org/vaccineswork/kickstarting-essential-immunisation-roll-outsDate: June 28, 2023Date accessed: September 1, 2023Google Scholar using a 1-week, three-dose regimen,4WHORabies vaccines: WHO position paper – April 2018.https://www.who.int/publications/i/item/who-wer9316Date: April 19, 2018Date accessed: September 1, 2023Google Scholar there is hope to reach or at least come close to the goal of Zero by 30. Eliminating dog-mediated human rabies will not only save an estimated 300 000 lives within 5 years, but also strengthen health systems at all levels.5Hampson K Ventura F Steenson R et al.The potential effect of improved provision of rabies post-exposure prophylaxis in Gavi-eligible countries: a modelling study.Lancet Infect Dis. 2019; 19: 102-111Summary Full Text Full Text PDF PubMed Scopus (51) Google Scholar The planning of the roll-out is underway. A call for the expression of interest is anticipated to be published in 2024 for eligible endemic countries. Despite this positive development, societal and public health costs due to rabies will continue to grow if the complementary strategy of mass dog vaccination is not implemented. Vaccinating dogs—the main carriers of rabies to other animals and humans in most of Asia, Africa, and South America—is crucial to stop the transmission of this disease at its source.6Cleaveland S Thumbi SM Sambo M et al.Proof of concept of mass dog vaccination for thecontrol and elimination of canine rabies.Rev Sci Tech. 2018; 37: 559-568Crossref PubMed Scopus (22) Google Scholar This mass vaccination of dogs is possible through a strong and committed collaboration of the human and the veterinary health sectors, and would be a true example of One Health in action. Unfortunately, the systematic scaling up of mass dog vaccination is slow and was highly affected by the COVID-19 pandemic.7Nadal D Abela-Ridder B Beeching S et al.The impact of the first year of the COVID-19 pandemic on canine rabies control efforts: a mixed-methods study of observations about the present and lessons for the future.Front Trop Dis. 2022; 3866811Crossref Scopus (5) Google Scholar Many countries have developed their strategic plans, but these need to receive adequate, long-term attention and investment to be implemented.8Wallace RM Undurraga EA Blanton JD Cleaton J Franka R Elimination of dog-mediated human rabies deaths by 2030: needs assessment and alternatives for progress based on dog vaccination.Front Vet Sci. 2017; 4: 9Crossref PubMed Scopus (123) Google Scholar To support countries' efforts, the United Against Rabies initiative (a One Health collaboration launched in 2020 by the Food and Agriculture Organization of the United Nations, the World Organisation for Animal Health, and WHO to accelerate progress towards Zero by 30) has gathered a broad range of stakeholders to advocate, cooperate with, and support the implementation of national rabies control programmes that rely on awareness and education, human post-exposure prophylaxis, and mass dog vaccination.9United Against RabiesUnited Against Rabies Forum 2022 review.https://www.unitedagainstrabies.org/governance-policies/united-against-rabies-forum-2022-review/Date: January, 2023Date accessed: September 1, 2023Google Scholar An area of essential and urgent need is the collection of better data to guide planning and monitoring. Although human and animal rabies are notifiable diseases in many countries, rabies surveillance often remains weak. WHO and its partners have developed tools to aid countries in the collection of minimum indicators, be better able to understand where efforts are required, set aside the necessary resources, and measure progress.10WHOParticipate to improve global rabies data collection.https://www.who.int/activities/improving-data-on-rabiesDate accessed: September 1, 2023Google Scholar With the wider uptake of more holistic approaches to addressing health issues following the COVID-19 pandemic, rabies offers an important indicator of the impact these approaches have on human and animal health, and of progress in terms of One Health operationalisation, equity, and sustainable development. Every year on September 28, the world recognises World Rabies Day. The theme of 2023 is Rabies: All for 1, One Health for All. With relevant sectors and stakeholders locally, regionally, and internationally driving towards a common goal while lifesaving resources are becoming available for people and dogs, there is still hope to reach the target of Zero by 30 for dog-mediated human rabies. We declare no competing interests.